UM doctors release findings on health incidents that affected US diplomats in Havana

Michael E. Hoffer, M.D. at the University of Miami's Miller School of Medicine, talks about his team's research on the acute symptoms and clinical findings from the health incidents that affected U.S. diplomats in Havana.

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Michael E. Hoffer, M.D. at the University of Miami's Miller School of Medicine, talks about his team's research on the acute symptoms and clinical findings from the health incidents that affected U.S. diplomats in Havana.

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The Miami doctors who first treated U.S. diplomats in Havana affected by a mysterious ailment after exposure to an unknown energy source have found a “triad” of neurological, cognitive and emotional symptoms unlike the concussions previously reported by another group of physicians.

“Our findings are dramatically different from what concussions look like,” Dr. Michael Hoffer, the lead author of a new study made public Wednesday, said in an exclusive video interview with the Miami Herald and el Nuevo Herald. The study by physicians at the University of Miami and the University of Pittsburgh was published in Laryngoscope Investigative Otolaryngology journal.

Hoffer, a professor of Otolaryngology and Neurological Surgery at UM’s Miller School of Medicine, said the initial symptoms reported by 25 diplomats and family members point to an “acquired neurosensory dysfunction.” Another team of doctors at the University of Pennsylvania (UPenn) who examined the chronic symptoms of 21 of the patients concluded they suffered from mild traumatic brain injury, known as a concussion, even though none had suffered a blow to the head. Their report was published in the Journal of the American Medical Association (JAMA) in February.

“Concussions do look like many different things, but in our experience of thousands of concussion patients this group is different. They have a unique pattern of balance dysfunction and a unique pattern of cognitive dysfunction,” Hoffer said.

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Michael E. Hoffer, M.D., at the University of Miami Miller School of Medicine in Allapattah on Friday, Nov. 7, 2018. Hoffer is part of the team that released a study into the acute symptoms and clinical findings of U.S. diplomatic personnel living in Havana, Cuba, who experienced neurosensory symptoms after exposure to a unique sound/pressure phenomenon.

MATIAS J. OCNER mocner@miamiherald.com

The UM-Pitt team reviewed the initial exams of 25 diplomats and relatives examined in Miami within four days to two months after they were exposed to strong sounds or felt pressure-like sensations against their bodies while they were in Havana. Another 10 showed no symptoms but were evaluated because they were present when the incidents occurred or were exposed for a few seconds.

Most significantly, all 25 of the affected individuals showed abnormalities in the otolithic organs, which are part of the vestibular system of the inner ear that detect gravity and allow the body to adjust its position in space. Those abnormalities were not reported in the JAMA study.

In never before reported details, the study indicates that some of the victims heard the noise over several nights and that others, trying to figure out its source, inadvertently increased their exposure because “the noise followed them.”

The specific conclusions of the UPenn team “were not consistent with ours,” said Hillary Snapp, chief of Audiology and Associate Professor of Otolaryngology at the Miller School of Medicine. “They didn’t execute the same tests that we did, which is why we were able to find the otholitic abnormalities they did not report.”

Hoffer pointed out that the new study is based on the first examinations of the affected diplomats and relatives soon after they experienced the strange symptoms. The study was carried out at UM from March through June 2017, when the symptoms were acute, which Hoffner believes generated the most precise characterization of the lesions. The JAMA report is based on examinations of 21 diplomats and relatives carried out by UPenn personnel an average of six months after the incidents.

“We are describing the individuals near to the time of their injury, without the influence of time, that can really change the way symptoms looked, without the influence of a variety of treatments, without workers’ comp concerns and without the media coverage about what people should complain for,” Hoffer said.

“This is the only report on acute symptoms,” he added. “The Penn patients, they don’t count as unbiased observers. There is no comparison. It’s apple and oranges.”

The UM-Pittstudy identified the persons examined only as “diplomats” leaving open the possibility that not all of them were from the United States.

Hoffer examined 35 patients in Miami and 105 others at the U.S. embassy in Havana in the spring of 2017 — including Marines who guard the mission. None of the 105 examined in Cuba reported strange sounds or sensations. They were evaluated with the same protocols followed in Miami but showed no symptoms other than headaches.

The U.S. government has branded the incidents as “health attacks” and said they occurred in diplomatic homes and two Havana hotels, affecting at least 26 diplomats and intelligence agents from the end of 2016 until May of this year. Canada has reported 13 other cases at its Havana embassy, including four children.

The U.S. and Cuban governments say they don’t know what happened or who was responsible. But Washington has complained that Havana failed to protect its diplomats.

Cuba has denied any responsibility for the incidents, launched its own investigations and has requested more access to the medical data of the people affected. A State Department spokeswoman said in an email that “the investigation into the origin and source of the attacks continues. We do not have any additional information to share at this time.”

On Wednesday, Havana again denied any assertion that it was involved in any alleged attacks.

“In Cuba, no one is attacked or allowed to attack a diplomat of any country,” Carlos Fernández de Cossío, General Director for U.S. Affairs at the Cuban Ministry of Foreign Affairs, said in a speech. “The weapons capable of producing the effects that several U.S. officials and experts say they are finding do not exist anywhere in the world.”

De Cossío said it was irresponsible to “accuse Cuba” without Cuban investigators having access to the medical information of those affected. He also questioned whether the injuries suffered by the diplomats had originated on the island.

“It is not that we doubt that U.S. diplomats may have suffered ailments that were detected during their stay in Cuba, which we would regret, but this does not ensure that the origin of the disease is linked to their stay in Cuba,” he said.

At a press conference in Miami Wednesday, Hoffer responded to De Cossío’s statements.

“I cannot be sure, all I can say is that it happened, the noise and the pressure, and then the symptoms,” Dr. Hoffer said, adding that those affected did not know what to complain about before being evaluated.

It remains unclear why the UM-Pitt report, based on the first examinations of the affected patients, was published months after the UPenn study appeared in JAMA.

The different interpretations of the symptoms appear to have started early in the investigation. In July 2017, the State Department organized a panel of academics to analyze the preliminary results of diagnostic tests. Charles Rosenfarb, director of the department’s health services bureau, told a Senate hearing in January that the department, following the panel’s recommendation, endorsed the hypothesis that the incidents were similar to concussions and requested further research at UPenn’s Center for Brain Injury and Repair.

But sources familiar with the panel’s discussions said it reached no conclusions.

The UM-Pitt study was not commissioned by the State Department but went through its security clearance procedures “to make sure we were not releasing any classified information,” said Hoffer. “The process was very long.”

According to the State Department spokeswoman, the agency “was not requested to review nor did it receive a preliminary copy of the University of Miami’s recent article regarding ‘health attacks’ for Laryngoscope Investigative Otolaryngology.” But she said the State Department did receive an article last December submitted by Dr. Hoffer and proposed for publication in the New England Journal of Medicine. That article was cleared for publication on Feb. 20, 2018, but did not publish.

Hoffer said a copy of the study published Wednesday had been given to the State Department and that it took nine months for it to get clearance.

When they were first evaluated in Miami, the 25 patients presented a combination of the following symptoms: dizziness and balance problems, pain and ringing in the ears, loss of hearing, headaches and difficulty concentrating and processing information.

Special evaluations on nine patients who complained of cognitive problems confirmed they were having difficulties remembering words or visual images, concentrating or grabbing objects. Some also showed signs of anxiety or depression.

Tests with special goggles and other technology showed the patients had problems concentrating and carrying out cognitive tasks as simple as following a moving dot. Other tests to look into the complaints of dizziness showed that when the patients had no visual clues, they could not orient themselves adequately — a finding that eventually led to the diagnosis of abnormalities in the inner ear.

Hillary Snapp, Au.D, Ph.D., at the University of Miami Miller School of Medicine in Allapattah on Friday, Nov. 7, 2018. Snapp is part of the team that released a study of the symptoms and clinical findings in U.S. diplomatic personnel living in Havana who experienced neurosensory symptoms after exposure to a unique sound/pressure phenomenon.

MATIAS J. OCNER mocner@miamiherald.com

“There is a lot of speculation about hysteria and other things, and part of that is related to the fact that these individuals struggled to characterize what they were feeling, using the term ‘not quite right,’” said Snapp, UM’s chief of Audiology and Associate Professor of Otolaryngology. “But it really is a sense of disorientation, that is really very well linked to objective clinical findings” found in the exams.

“I ruled it out for a couple of reasons. First these are very high functional individuals that scored very well on selected tests and scoredvery poorly in others. There was such a specific pattern, that they wouldn’t know which tests to excel on and which tests to perform poorly,” said Dr Bonnie E. Levin, director of the Neuropsychology division at the Miller School of Medicine.

Levin added that they were “well educated (patients) who had a lot of training and experience, and they were performing below expectancy but still within the average to low-average range to many tests. So there was no attempt to distort, they were just performing below expectancy.”

From left, Hillary Snapp, Au.D, Ph.D., Michael E. Hoffer, M.D., and Bonnie E. Levin, Ph.D. at the University of Miami Miller School of Medicine in Allapattah on Friday, Nov. 7, 2018. They are part of the team that released a study into the acute symptoms and clinical findings in U.S. diplomatic personnel living in Havana who experienced neurosensory symptoms after exposure to a unique sound/pressure phenomenon.

MATIAS J. OCNER mocner@miamiherald.com

Some of those patients also showed emotional symptoms that concur with cognitive problems, indicating they might have a biological cause.

“I respect my Cuban colleagues immensely. They are excellent physicians. But in this particular instance, we have objective evidence. You don’t get an objective testing abnormality if it’s hysteria,” said Hoffer.

The UM-Pitt report authors also included their theory on what could have caused the symptoms. They wrote that although they don’t know the exact mechanism, directed energy sources, such as microwaves, can cause “cavitation bubbles in body fluids.”

The energy released when the bubbles burst can cause “a shock wave and acoustic emissions,” they wrote.

“People can hear radar pulses. This was first recorded in the late 1960s and we don’t normally think we can hear that but there was work done, it was funded by the Department of Defense through the late 1980s,” said Dr. Carey D. Balaban, professor of Otolaryngology at the University of Pittsburgh School of Medicine, who also contributed to the study.

“It shows that radar pulses can result in the production of sound inside the fluid, in the brain and can produce responses in the hearing system,” Balaban added. “So you can’t rule that out.”

The report also mentions previous investigations showing that intense ultrasonic radiation can produce a range of symptoms that include nausea, headaches, ringing in the ear, pain, dizziness and fatigue.

The majority of the patients in the study reported hearing odd sounds before their symptoms showed up.

“Several individuals reported that if they went outside their front door, the noise immediately stopped. Others reported a sensation of pressure passing through their head and abdomen in certain parts of the room that could be relieved by moving a few feet away,” the study noted.

Similar descriptions in the UPenn study and news media reports on the Havana incidents have triggered speculation that the symptoms were caused by some sort of directional energy source. But Hoffer and his colleagues urged caution. “It would be imprudent to exclude any potential source of directional or non-directional energy at this time,” the report said.

“It is important to be very careful. The key here is to be scientifically vigilant but skeptical,” saidBalaban.

The UM-Pitt collaboration left many questions unanswered, and much of the information on the case remains classified.

The authors could not come out with specific protection measures for U.S. diplomats in case of future incidents. The State Department withdrew most of its staff from Havana, and those still in Cuba are living in a smaller number of residences to minimize the risks.

The doctors interviewed by el Nuevo Herald and the Miami Herald declined to answer specific questions about the patients and their possibilities of total recovery.

Hoffer and Balaban also declined to comment on the possible existence of “neuro-weapons” — a theory that they and Dr. James Giordano, a professor of neurology and biochemistry at Georgetown University, addressed in an article published in National Defense Magazine.

“The evidence suggests that they were targeted,” Hoffer said with a pause, “but we can not prove that.”